[Federal Register Volume 74, Number 78 (Friday, April 24, 2009)]
[Rules and Regulations]
[Pages 18656-18657]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-9232]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 447 and 455

[CMS-2198-F2]
RIN-0938-AN09


Medicaid Program; Disproportionate Share Hospital Payments; 
Correcting Amendment

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final rule; correcting amendment.

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SUMMARY: This correcting amendment corrects a technical error in the 
regulations text in the final rule published in the Federal Register on 
December 19, 2008 (73 FR 77904) entitled, ``Disproportionate Share 
Hospital Payments.'' In that final rule, we set forth data elements 
necessary to

[[Page 18657]]

comply with the requirements of section 1923(j) of the Social Security 
Act (the Act) related to auditing and reporting of disproportionate 
share hospital payments under State Medicaid programs. The effective 
date was January 19, 2009.

DATES: Effective Date: This correcting amendment is effective April 24, 
2009.

FOR FURTHER INFORMATION CONTACT: 
    Venesa Day, (410) 786-8281.
    Rory Howe, (410) 786-4878.
    Rob Weaver, (410) 786-5914.

SUPPLEMENTARY INFORMATION: 

I. Background

    In FR Doc. E8-30000 issued on December 19, 2008 (73 FR 77904), 
there was a technical error that is identified and corrected in this 
correcting amendment. The correction in this document is effective 
April 24, 2009.

II. Summary of Error in the Regulations Text

    On page 77950 of the final rule, we made a technical error in the 
regulation text of Sec.  447.299(c)(16). In this paragraph, the text 
provides a narrative description of how ``total annual uncompensated 
care costs'' are to be calculated from component data elements. The 
first sentence accurately names the component data elements and 
correctly describes the calculation. The last sentence attempts to 
condense the previous sentence by substituting references for component 
data elements as identified in previous paragraphs of Sec.  447.299(c). 
However, the references are unintentionally incorrect.
    The last sentence of the original final text indicates that the sum 
of paragraphs (c)(11) and (c)(15) should be subtracted from (c)(9), 
(c)(12), and (c)(13). This calculation would sum Medicaid uncompensated 
care costs and total uninsured inpatient and outpatient uncompensated 
care costs, then subtract this total from the sum of total Medicaid 
inpatient and outpatient payments, uninsured inpatient and outpatient 
revenue, and total applicable Section 1011 payments. This calculation 
is incorrect and could not be interpreted reasonably to result in 
``total annual uncompensated care costs''. Additionally, it erroneously 
contradicts section 1923(g) of the Social Security Act (the Act), Sec.  
447.299 and Sec.  455 subpart D, and longstanding CMS policy.
    The corrected text of the last sentence should read as follows: 
``This should equal the sum of paragraphs (c)(9), (c)(12), and (c)(13) 
subtracted from the sum of paragraphs (c)(10) and (c)(14) of this 
section.'' This correction includes the correct references necessary to 
calculate accurately ``total uncompensated care costs'' consistent with 
section 1923(g) of the Act, Sec.  447.299 and Sec.  455 Subpart D, and 
longstanding CMS policy.

IV. Waiver of Proposed Rulemaking and Delay in Effective Date

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register to provide a period for public comment before the 
provisions of a rule take effect in accordance with section 553(b) of 
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we 
can waive this notice and comment procedure if the Secretary finds, for 
good cause, that the notice and comment process is impracticable, 
unnecessary, or contrary to the public interest, and incorporates a 
statement of the finding and the reasons therefore in the notice.
    Section 553(d) of the APA ordinarily requires a 30-day delay in 
effective date of final rules after the date of their publication in 
the Federal Register. This 30-day delay in effective date can be 
waived, however, if an agency finds for good cause that the delay is 
impracticable, unnecessary, or contrary to the public interest, and the 
agency incorporates a statement of the findings and its reasons in the 
rule issued.
    This action merely corrects a technical error in the December 19, 
2008 final rule. We are not changing the policy contained in that rule, 
and further public comment is unnecessary. Therefore, we find there is 
good cause to waive notice and comment procedures and the 30-day delay 
in effective date for this action.

List of Subjects in 42 CFR Part 447

    Accounting, Administrative practice and procedure, Drugs, Grant 
programs-health, Health facilities, Health professions, Medicaid, 
Reporting and recordkeeping requirements, and Rural areas.

0
Accordingly, 42 CFR chapter IV is corrected by making the following 
correcting amendment to part 447:

PART 447--PAYMENTS FOR SERVICES

0
1. The authority citation for part 447 continues to read as follows:

    Authority:  Secs. 1102 of the Social Security Act (42 U.S.C. 
1302).


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2. Section 447.299 is amended by revising paragraph (c)(16) to read as 
follows:


Sec.  447.299  Reporting Requirements

    (c) * * *
    (16) Total annual uncompensated care costs. The total annual 
uncompensated care cost equals the total cost of care for furnishing 
inpatient hospital and outpatient hospital services to Medicaid 
eligible individuals and to individuals with no source of third party 
coverage for the hospital services they receive less the sum of regular 
Medicaid FFS rate payments, Medicaid managed care organization 
payments, supplemental/enhanced Medicaid payments, uninsured revenues, 
and Section 1011 payments for inpatient and outpatient hospital 
services. This should equal the sum of paragraphs (c)(9),(c)(12), and 
(c)(13) subtracted from the sum of paragraphs (c)(10) and (c)(14) of 
this section.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program)

    Dated: April 13, 2009.
Ashley Files Flory,
Acting Executive Secretary to the Department.
[FR Doc. E9-9232 Filed 4-23-09; 8:45 am]
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